Following the British government's rejection of an across-the-board pay rise, hundreds of thousands of workers in England's state-run National Health Service went on strike on Monday. Such an action has happened for the first time since 1982.
Midwives taking their first ever industrial action joined NHS nurses and ambulance crews across the country in stopping working for four hours.
AdvertisementAs picket lines formed outside hospitals, emergency services were maintained as part of a deal with managers, although London's ambulance service had the police and military on standby.
"We want the government to realise that we're doing a very hard job and under very difficult circumstances, and we just want to be paid fairly," said pediatric nurse Karen Buonaiuto, one of a dozen striking staff gathered outside St Mary's Hospital in London.
The action is intended to put pressure on Health Secretary Jeremy Hunt, who rejected the recommendations of an independent pay panel for a below-inflation, one-percent wage increase for all health service staff.
Hunt has only agreed to implement the one-percent rise for the four in 10 workers who do not already receive an incremental salary increase linked to their professional development.
"The majority of NHS staff get an automatic three-percent increment but we can't afford to give a one-percent rise to people already getting that," the minister said.
He told BBC radio: "We have had very clear analysis that if we did that, hospital chief executives would lay off around 4,000 nurses this year and around 10,000 nurses next year."
The Conservative-Liberal Democrat coalition government has roughly halved Britain's budget deficit from 11 percent of gross domestic product (GDP) since taking office in 2010.
But the continued belt-tightening has been criticised by trade unions citing the health of the British economy, which is expected to grow by three percent in 2014.
- Unions say 'Enough's enough' -
Trades Union Congress (TUC) general secretary Frances O'Grady, who joined a picket line in London, said morale had hit "rock-bottom".
"NHS staff faced year-on-year cuts in the relative value of their pay," she said.
Union leaders say that small pay increases plus inflation mean the value of NHS pay has fallen by 12 percent since 2011.
Among several unions taking industrial action, the Royal College of Midwives went on strike for the first time in its 133-year existence.
After the walkout, union workers will keep up the pressure by insisting on taking their breaks and refusing to work overtime between Tuesday and Friday.
Meanwhile a TUC-organised national protest will be staged in London on Saturday under the banner Britain Needs A Pay Rise.
Hunt said he was prepared to talk to the unions, but only if they were prepared to consider reforming the "unclear and unfair" system of increments.
The striking unions count more than 400,000 members among the 1.3 million NHS staff in England.
Only the Chinese army, the Indian railways and US supermarket chain Wal-Mart have more employees than the NHS, according to the British government.
Created in 1948 and paid for through taxation, the NHS provides universal healthcare free at the point of delivery.
- NHS an election battleground -
The strike comes seven months ahead of the May 2015 general election, and both parties are putting the NHS at the heart of their campaigns.
The opposition Labour Party accuses the Conservatives of planning to dismantle the health service by privatising parts of it, and has promised more funding.
Conservative Prime Minister David Cameron has accused Labour of scaremongering and has vowed to protect the NHS budget from spending cuts.
Kristian Niemietz, a senior research fellow at the free-market think tank the Institute of Economic Affairs, said the NHS was always a key election topic, but predicted a "very shallow debate".
"The only politically palatable statements on the NHS are to shower it with praise, and to promise to spend more money on it," he said.
He said British health workers were "not underpaid" compared to other countries and while pay rates have stagnated, "the same is true for most sectors of the economy" during what has been a prolonged slump and slow recovery.